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Abstract

It is suggested that older adults have more difficulty maintaining sleep than younger adults, and that sleep also becomes more fragmented with increasing age. The aim of this thesis was to assess sleep patterns in older adults, and to investigate some pharmacological agents taken by older adults as sleep aids. A survey of 5846 older adults identified sleep complaints and methods of alleviation. Results supported previous findings, and pain and nocturia were found to be the main reasons for nocturnal awakenings. Respondents reported the use of hypnotics, antidepressants, over-the-counter preparations and herbal remedies as sleep aids. Respondents also used whisky, hot milky drinks and reading at bedtime to aid sleep. Three placebo-controlled clinical trials were implemented to assess the effects of a herbal remedy (valerian), three hypnotics (loprazolam, zopiclone and zolpidem), and two antidepressants (dothiepin and moclobemide) on sleep and daytime performance. Results showed few advantageous effects of an acute dose of valerian. Loprazolam, zopiclone and zolpidem were given to younger adults to assess these treatments without the confounds of old age. These treatments were found to be effective hypnotics from the first night of use, but there were more residual sedative effects under loprazolam than zopiclone or zolpidem. Neither dothiepin nor moclobemide were found to be suitable for use as sleep aids, also using a younger population. Findings indicate most older adults do not have sleep complaints, but those who do are likely to have sleep problems due to physical reasons. More research is necessary into the duration of valerian use and doses for efficacy. Residual sedative effects under loprazolam may increase the risk of accidents, and shorter acting hypnotics, such as zopiclone and zolpidem, may reduce this risk. Dothiepin showed more sedative effect than moclobemide, but there was little evidence of improved sleep. Further research is necessary to establish the causes of poor sleep in old age, and to assess the suitability of other sleep aids in this age group.